Hyperthermic intraperitoneal chemotherapy in recurrent ovarian cancer: An updated systematic review and meta-analysis.

Abstract

5584 Background: Ovarian cancer is the leading cause of mortality among gynecological malignancies in women. Disease recurrence remains a formidable challenge in the management of primary ovarian cancer. This systematic review and meta-analysis evaluate the impact of hyperthermic intraperitoneal chemotherapy (HIPEC) on overall survival (OS) and progression-free survival(PFS) in patients with recurrent ovarian cancer. Methods: A comprehensive literature search was conducted in PubMed, Embase, and Cochrane databases to identify randomized controlled trials (RCTs) published up to November 2024, comparing the outcomes of HIPEC combined with cytoreductive surgery (CRS) versus CRS alone in patients with recurrent ovarian cancer. A total of 459 articles were screened in accordance with the PRISMA guidelines. The primary endpoints analyzed were OS, PFS, and postoperative complications. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using the inverse variance method for time-to-event outcomes, while the Mantel-Haenszel method was applied for binary outcomes to estimate relative risk (RR) and corresponding 95% CIs. Statistical heterogeneity was assessed using Cochrane's Q test and Higgins' I² statistic. Statistical significance was set at a p-value < 0.05. Data analysis was performed using R software version 4.4.2. Results: Following the screening process, four RCTs involving a total of 801 patients were included in the meta-analysis, and 398 patients (49.6%) received HIPEC. The pooled analysis demonstrated a non-significant improvement in OS for the HIPEC group (HR 0.8; 95% CI [0.55, 1.17]; p=0.159). Similarly, PFS did not significantly differ between the treatment and control groups (HR 1.04; 95% CI[0.46, 2.35];p=0.867). In terms of postoperative complications, patients who underwent HIPEC were at a significantly increased risk of developing anemia (RR 1.36; 95% CI[1.08, 1.72];p=0.028) and sepsis (RR 2.11; 95% CI[1.44, 3.08];p=0.014). However, no significant differences were observed between the treatment and control groups regarding other postoperative complications, including urinary tract infection (RR 0.95;95% CI[0.19, 4.69];p=0.895), bowel obstruction (RR 0.77; 95% CI [0.25, 2.37]; p=0.426), pleural effusion (RR 1.49;95% CI[0.16, 14.16];p=0.525), and thrombosis (RR 1.99;95% CI[0.98, 4.07];p=0.053). Conclusions: The findings suggest that while HIPEC may offer a potential, albeit statistically non-significant, survival benefit in patients with recurrent ovarian cancer, it is associated with an increased risk of anemia and sepsis.